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Dos Santos Nascimento IJ, Albino SL, da Silva Menezes KJ, de Azevedo Teotônio Cavalcanti M, de Oliveira MS, Mali SN, de Moura RO. Targeting SmCB1: Perspectives and Insights to Design Antischistosomal Drugs. Curr Med Chem 2024; 31:2264-2284. [PMID: 37921174 DOI: 10.2174/0109298673255826231011114249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 11/04/2023]
Abstract
Neglected tropical diseases (NTDs) are prevalent in tropical and subtropical countries, and schistosomiasis is among the most relevant diseases worldwide. In addition, one of the two biggest problems in developing drugs against this disease is related to drug resistance, which promotes the demand to develop new drug candidates for this purpose. Thus, one of the drug targets most explored, Schistosoma mansoni Cathepsin B1 (SmCB1 or Sm31), provides new opportunities in drug development due to its essential functions for the parasite's survival. In this way, here, the latest developments in drug design studies targeting SmCB1 were approached, focusing on the most promising analogs of nitrile, vinyl sulphones, and peptidomimetics. Thus, it was shown that despite being a disease known since ancient times, it remains prevalent throughout the world, with high mortality rates. The therapeutic arsenal of antischistosomal drugs (ASD) consists only of praziquantel, which is widely used for this purpose and has several advantages, such as efficacy and safety. However, it has limitations, such as the impossibility of acting on the immature worm and exploring new targets to overcome these limitations. SmCB1 shows its potential as a cysteine protease with a catalytic triad consisting of Cys100, His270, and Asn290. Thus, design studies of new inhibitors focus on their catalytic mechanism for designing new analogs. In fact, nitrile and sulfonamide analogs show the most significant potential in drug development, showing that these chemical groups can be better exploited in drug discovery against schistosomiasis. We hope this manuscript guides the authors in searching for promising new antischistosomal drugs.
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Affiliation(s)
- Igor José Dos Santos Nascimento
- Pharmacy Department, Cesmac University Center, Maceió, 57051-160, Brazil
- Laboratório de Desenvolvimento e Síntese de Fármacos, Departamento de Farmácia, Universidade Estadual da Paraíba, Campina Grande 58429-500, Brazil
- Programa de Pós Graduação em Ciências Farmacêuticas, Universidade Estadual da Paraíba, Campina Grande, 58429-500, Brazil
| | - Sonaly Lima Albino
- Laboratório de Desenvolvimento e Síntese de Fármacos, Departamento de Farmácia, Universidade Estadual da Paraíba, Campina Grande 58429-500, Brazil
| | - Karla Joane da Silva Menezes
- Laboratório de Desenvolvimento e Síntese de Fármacos, Departamento de Farmácia, Universidade Estadual da Paraíba, Campina Grande 58429-500, Brazil
- Programa de Pós Graduação em Ciências Farmacêuticas, Universidade Estadual da Paraíba, Campina Grande, 58429-500, Brazil
| | - Misael de Azevedo Teotônio Cavalcanti
- Laboratório de Desenvolvimento e Síntese de Fármacos, Departamento de Farmácia, Universidade Estadual da Paraíba, Campina Grande 58429-500, Brazil
- Programa de Pós Graduação em Ciências Farmacêuticas, Universidade Estadual da Paraíba, Campina Grande, 58429-500, Brazil
| | - Mozaniel Santana de Oliveira
- Coordination of Botany-Laboratory Adolpho Ducke, Avenida Perimetral, Museu Paraense Emílio Goeldi, 1901, Belém, 66077-530, PA Brazil
| | - Suraj N Mali
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Matunga East, Mumbai, 400019, India
| | - Ricardo Olimpio de Moura
- Laboratório de Desenvolvimento e Síntese de Fármacos, Departamento de Farmácia, Universidade Estadual da Paraíba, Campina Grande 58429-500, Brazil
- Programa de Pós Graduação em Ciências Farmacêuticas, Universidade Estadual da Paraíba, Campina Grande, 58429-500, Brazil
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Lvova MN, Ponomarev DV, Tarasenko AA, Kovner AV, Minkova GA, Tsyganov MA, Li M, Lou Y, Evseenko VI, Dushkin AV, Sorokina IV, Tolstikova TG, Mordvinov VA, Avgustinovich DF. Curcumin and Its Supramolecular Complex with Disodium Glycyrrhizinate as Potential Drugs for the Liver Fluke Infection Caused by Opisthorchis felineus. Pathogens 2023; 12:819. [PMID: 37375509 DOI: 10.3390/pathogens12060819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Opisthorchiosis is a parasitic liver disease found in mammals that is widespread throughout the world and causes systemic inflammation. Praziquantel remains the drug of choice for the treatment of opisthorchiosis, despite its many adverse effects. An anthelmintic effect is attributed to the main curcuminoid of Curcuma longa L. roots-curcumin (Cur)-along with many other therapeutic properties. To overcome the poor solubility of curcumin in water, a micellar complex of curcumin with the disodium salt of glycyrrhizic acid (Cur:Na2GA, molar ratio 1:1) was prepared via solid-phase mechanical processing. In vitro experiments revealed a noticeable immobilizing effect of curcumin and of Cur:Na2GA on mature and juvenile Opisthorchis felineus individuals. In vivo experiments showed that curcumin (50 mg/kg) had an anthelmintic effect after 30 days of administration to O. felineus-infected hamsters, but the effect was weaker than that of a single administration of praziquantel (400 mg/kg). Cur:Na2GA (50 mg/kg, 30 days), which contains less free curcumin, did not exert this action. The complex, just as free curcumin or better, activated the expression of bile acid synthesis genes (Cyp7A1, Fxr, and Rxra), which was suppressed by O. felineus infection and by praziquantel. Curcumin reduced the rate of inflammatory infiltration, whereas Cur:Na2GA reduced periductal fibrosis. Immunohistochemically, a decrease in liver inflammation markers was found, which is determined by calculating the numbers of tumor-necrosis-factor-positive cells during the curcumin treatment and of kynurenine-3-monooxygenase-positive cells during the Cur:Na2GA treatment. A biochemical blood test revealed a normalizing effect of Cur:Na2GA (comparable to that of curcumin) on lipid metabolism. We believe that the further development and investigation of therapeutics based on curcuminoids in relation Opisthorchis felineus and other trematode infections will be useful for clinical practice and veterinary medicine.
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Affiliation(s)
- Maria N Lvova
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Denis V Ponomarev
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Alena A Tarasenko
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Anna V Kovner
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Galina A Minkova
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Michail A Tsyganov
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
- Department of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Meijun Li
- Department of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Yan Lou
- Department of Natural Sciences, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Veronica I Evseenko
- Institute of Solid State Chemistry and Mechanochemistry, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Alexander V Dushkin
- Institute of Solid State Chemistry and Mechanochemistry, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Irina V Sorokina
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Tatiana G Tolstikova
- N.N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Viatcheslav A Mordvinov
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Damira F Avgustinovich
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
- Institute of Solid State Chemistry and Mechanochemistry, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
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3
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Pharmacokinetics of Ascending Doses of Praziquantel in Adults Infected with Opisthorchis felineus in Western Siberia, Russian Federation. Antimicrob Agents Chemother 2022; 66:e0052622. [PMID: 36094183 PMCID: PMC9578388 DOI: 10.1128/aac.00526-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Opisthorchiasis due to the liver fluke Opisthorchis felineus is highly prevalent in rural regions of Western Siberia, causing severe liver and bile duct maladies. Praziquantel administered as a three-dose regimen is the only drug used to treat O. felineus-infected individuals. A simpler single-dose treatment might serve as an alternative. The aim of this study was to compare the pharmacokinetic (PK) properties of single, ascending doses of praziquantel compared to multiple dosing in patients infected with O. felineus to contribute to updated treatment guidelines. Dried blood spots (DBSs) of 110 adults were collected at 11 time points post-drug administration at single oral doses of 20, 40, and 60 mg/kg, as well as 3× 20 mg/kg (4 h dosing interval). DBS samples were analyzed using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method, and PK parameters were obtained for R-, S-, and R-trans-4-OH-praziquantel employing noncompartmental analysis. We observed the highest drug exposure for all analytes when the triple-dose scheme was used; area under the concentration-time curve from 0 to 24 h (AUC0-24) values of 8.04, 27.75, and 36.38 μg/mL·h were obtained, respectively. Maximal plasma concentrations (Cmax) values of 1.72, 4.89, and 2.69 μg/mL were calculated for R-, S-, and R-trans-4-OH-praziquantel, respectively, when patients were given a single 60-mg/kg dose, and they peaked at 1.5 and 2 h for the enantiomers and at 3 h for the metabolite. The herein-generated PK data, together with results that will be obtained from the integrated efficacy study, lay the groundwork for a possibly optimized treatment scheme for O. felineus-infected patients.
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R-praziquantel integrated population pharmacokinetics in preschool- and school-aged African children infected with Schistosoma mansoni and S. haematobium and Lao adults infected with Opisthorchis viverrini. J Pharmacokinet Pharmacodyn 2022; 49:293-310. [PMID: 35024995 DOI: 10.1007/s10928-021-09791-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/01/2021] [Indexed: 12/18/2022]
Abstract
Racemic praziquantel (PZQ) is the standard treatment for schistosomiasis and liver fluke infections (opisthorchiasis and clonorchiasis). The development of an optimal pediatric formulation and dose selection would benefit from a population pharmacokinetic (popPK) model. A popPK model was developed for R-PZQ, the active enantiomer of PZQ, in 664 subjects, 493 African children (2-15 years) infected with Schistosoma mansoni and S. haematobium, and 171 Lao adults (15-78 years) infected with Opisthorchis viverrini. Racemate tablets were administered as single doses of 20, 40 and 60 mg/kg in children and 30, 40 and 50 mg/kg in 129 adults, and as 3 × 25 mg/kg apart in 42 adults. Samples collected by the dried-blood-spot technique were assayed by LC-MS/MS. A two-compartment disposition model, with allometric scaling and dual first-order and transit absorption, was developed using Phoenix™ software. Inversely parallel functions of age described the apparent oral bioavailability (BA) and clearance maturation in children and ageing in adults. BA decreased slightly in children with dose increase, and by 35% in adults with multiple dosing. Crushing tablets for preschool-aged children increased the first-order absorption rate by 64%. The mean transit absorption time was 70% higher in children. A popPK model for R-PZQ integrated African children over 2 years of age with schistosomiasis and Lao adults with opisthorchiasis, and should be useful to support dose optimization in children. In vitro hepatic and intestinal metabolism data would help refining and validating the model in younger children as well as in target ethnic pediatric and adult groups.
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Walker M, Freitas LT, Halder JB, Brack M, Keiser J, King CH, Levecke B, Ai-Lian Lim Y, Pieri O, Sow D, Stothard JR, Webster JP, Zhou XN, Terry RF, Guérin PJ, Basáñez MG. Improving anthelmintic treatment for schistosomiasis and soil-transmitted helminthiases through sharing and reuse of individual participant data. Wellcome Open Res 2022; 7:5. [PMID: 35493199 PMCID: PMC9020536 DOI: 10.12688/wellcomeopenres.17468.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
The Infectious Diseases Data Observatory (IDDO, https://www.iddo.org) has launched a clinical data platform for the collation, curation, standardisation and reuse of individual participant data (IPD) on treatments for two of the most globally important neglected tropical diseases (NTDs), schistosomiasis (SCH) and soil-transmitted helminthiases (STHs). This initiative aims to harness the power of data-sharing by facilitating collaborative joint analyses of pooled datasets to generate robust evidence on the efficacy and safety of anthelminthic treatment regimens. A crucial component of this endeavour has been the development of a Research Agenda to promote engagement with the SCH and STH research and disease control communities by highlighting key questions that could be tackled using data shared through the IDDO platform. Here, we give a contextual overview of the priority research themes articulated in the Research Agenda-a 'living' document hosted on the IDDO website-and describe the three-stage consultation process behind its development. We also discuss the sustainability and future directions of the platform, emphasising throughout the power and promise of ethical and equitable sharing and reuse of clinical data to support the elimination of NTDs.
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Affiliation(s)
- Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Luzia T. Freitas
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Julia B. Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Matthew Brack
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bruno Levecke
- Department of Translational Physiology, Ghent University, Merelbeke, Belgium
| | - Yvonne Ai-Lian Lim
- Department of Parasitology, University of Malaya, Kuala Lumpur, Malaysia
| | - Otavio Pieri
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fiocruz, Rio de Janiero, Brazil
| | - Doudou Sow
- Service de Parasitologie, Université Gaston Berger de Saint Louis, Saint Louis, Senegal
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanne P. Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, China Center for Disease Control and Prevention, Shanghai, China
| | - Robert F. Terry
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | | | - Maria-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
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Zdesenko G, Mutapi F. Drug metabolism and pharmacokinetics of praziquantel: A review of variable drug exposure during schistosomiasis treatment in human hosts and experimental models. PLoS Negl Trop Dis 2020; 14:e0008649. [PMID: 32976496 PMCID: PMC7518612 DOI: 10.1371/journal.pntd.0008649] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Schistosomiasis control is heavily reliant on the drug praziquantel (PZQ), which is used as preventive chemotherapy as part of national helminth control strategies. Given the heavy reliance on PZQ for mass drug administration, there has been considerable research on the potential of parasites developing resistance to the drug, resulting in decreased drug efficacy. However, there have been comparatively fewer studies of other factors that can potentially alter PZQ efficacy. Here, we investigate whether host PZQ metabolism contributes towards variable cure rates. We evaluate factors that can influence the metabolism of PZQ and the resultant effect on the efficacy of PZQ treatment to determine factors that potentially influence an individual's response to the drug. The literature search was directed at published studies from three online databases: Web of Science, PubMed, and EMBASE. The search terms for the review comprised of ([praziquantel OR PZQ] AND [schistosom* OR bilharzia] AND [pharmaco*]) and included studies evaluating PZQ metabolism. Publications were categorised into pharmacokinetics, drug-drug interactions, pharmacogenetics, and metabolite analysis. Forty publications describing human and experimental studies fitted the inclusion criteria and were subjected to data extraction and analysis. The analyses showed that variable exposure to PZQ was associated with alterations in the liver's capacity to metabolise PZQ and observed drug-drug interactions. Other factors influencing the efficacy of PZQ were brand, formulation, and co-administered food. Although some work has been performed on metabolite identification, there was minimal information on PZQ's metabolic pathway, and no pharmacogenetics studies were identified. The study indicated that in both human and experimental studies alterations in the liver's capacity to metabolise PZQ as well as drug-drug interactions affected systemic levels of PZQ that could result in variable cure rates. The study confirmed previous findings of higher antischistosomal activity of (R)-PZQ enantiomer when administered alone compared to the racemate at the same dose as well as improved efficacy when the drug is administered with food. The study also highlighted the need for more comprehensive studies of the PZQ metabolic pathway and PZQ pharmacogenetic studies in humans.
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Affiliation(s)
- Grace Zdesenko
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, King’s Buildings, Edinburgh, United Kingdom
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Population Pharmacokinetics of Praziquantel in Pregnant and Lactating Filipino Women Infected with Schistosoma japonicum. Antimicrob Agents Chemother 2020; 64:AAC.00566-20. [PMID: 32631820 PMCID: PMC7449211 DOI: 10.1128/aac.00566-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023] Open
Abstract
An estimated 40 million women of reproductive age are infected with one of three species of the waterborne parasite Schistosoma spp. Treatment with praziquantel (PZQ) via mass drug administration (MDA) campaigns is the mainstay of schistosomiasis control for populations living in areas of endemicity. The World Health Organization recommends that pregnant and lactating women be included in schistosomiasis MDA programs, and several recent studies have evaluated the safety and efficacy of PZQ use during pregnancy. To date, there are no data describing PZQ pharmacokinetics (PK) during pregnancy or among lactating postpartum women. As part of a randomized controlled trial investigating the safety and efficacy of PZQ during human pregnancy, we examined the PK of this therapeutic drug among three distinct cohorts of women infected with S. japonicum in Leyte, Philippines. Specifically, we studied the PK properties of PZQ among early- and late-gestation pregnant women (n = 15 each) and lactating postpartum women (n = 15) with schistosomiasis. We found that women in early pregnancy had increased apparent clearance and lower area-under-the-curve (AUC0-24) values that may be related to physiological changes in drug clearance and/or changes in oral bioavailability. There was no relationship between body weight and apparent clearance. The mean ± standard deviation partition ratio of plasma to breast milk was 0.36. ± 0.13. The estimated median infant PZQ daily dose would be 0.037 mg/kg of body weight ingested from breast milk, which is significantly lower than the dosage required for antischistosomal activity and not known to be harmful to the infant. Our PK data do not support the suggestion to delay breastfeeding 72 h after taking PZQ. Results can help inform future drug efficacy studies in pregnant and lactating women with schistosomiasis.
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Martinez MN, Greene J, Kenna L, Kissell L, Kuhn M. The Impact of Infection and Inflammation on Drug Metabolism, Active Transport, and Systemic Drug Concentrations in Veterinary Species. Drug Metab Dispos 2020; 48:631-644. [PMID: 32503881 DOI: 10.1124/dmd.120.090704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/27/2020] [Indexed: 12/19/2022] Open
Abstract
Within human medicine, it is recognized that the pharmacokinetics (PK) of many compounds can be altered by the presence of inflammation or infection. Research into the reason for these changes has identified pathways that can influence drug absorption, clearance, and tissue distribution. In contrast, far less is known about these relationships within the framework of veterinary medicine. Rather, most of the PK data generated in veterinary species employs healthy subjects, raising the question of whether these studies are founded on an assumption that healthy animal PK reflect that of the diseased animal population. Accordingly, there is a need to explore the PK changes that might be overlooked in studies that recruit only healthy animals to assesses drug PK. To meet this objective, we surveyed the published literature for studies focusing on the impact of disease on the dose-exposure relationships in food-producing and companion animal species. We found that, consistent with humans and laboratory species, both up- and downregulation of the various cytochrome isoenzymes and/or transporters have occurred in response to an increase in inflammatory mediators. These findings suggest that, as observed in human medicine, the potential for differences in the drug PK in healthy versus animal patients points to a need for acquiring a greater understanding of these changes and how they may influence the dose-exposure-response relationships of veterinary pharmaceuticals. SIGNIFICANCE STATEMENT: This review delivers a much-needed summary of published information that provides insights into how disease and inflammation can influence the appropriateness of extrapolating laboratory-based dose-exposure-response relationships to what will occur in the actual veterinary patient. As part of this review, we also examine some of the method-associated issues to be considered when assessing the reported nature and magnitude of these changes.
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Affiliation(s)
- Marilyn N Martinez
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Rockville, Maryland (M.N.M., J.G., L.Ke., L.Ki.) and Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan (M.K.)
| | - Jonathan Greene
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Rockville, Maryland (M.N.M., J.G., L.Ke., L.Ki.) and Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan (M.K.)
| | - Leslie Kenna
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Rockville, Maryland (M.N.M., J.G., L.Ke., L.Ki.) and Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan (M.K.)
| | - Lindsey Kissell
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Rockville, Maryland (M.N.M., J.G., L.Ke., L.Ki.) and Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan (M.K.)
| | - Matt Kuhn
- Office of New Animal Drug Evaluation, Center for Veterinary Medicine, Rockville, Maryland (M.N.M., J.G., L.Ke., L.Ki.) and Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan (M.K.)
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Abstract
About one-sixth of the world's population is affected by a neglected tropical disease as defined by the World Health Organization and Center for Disease Control. Parasitic diseases comprise most of the neglected tropical disease list and they are causing enormous amounts of disability, morbidity, mortality, and healthcare costs worldwide. The burden of disease of the top five parasitic diseases has been estimated to amount to a total 23 million disability-adjusted life-years. Despite the massive health and economic impact, most drugs currently used for the treatment of parasitic diseases have been developed decades ago and insufficient novel drugs are being developed. The current review provides a compilation of the systemic and target-site pharmacokinetics of established antiparasitic drugs. Knowledge of the pharmacokinetic profile of drugs allows for the examination and possibly optimization of existing dosing schemes. Many symptoms of parasitic diseases are caused by parasites residing in different host tissues. Penetration of the antiparasitic drug into these tissues, the target site of infection, is a prerequisite for a successful treatment of the disease. Therefore, for the examination and improvement of established dosing regimens, not only the plasma but also the tissue pharmacokinetics of the drug have to be considered. For the current paper, almost 7000 scientific articles were identified and screened from which 429 were reviewed in detail and 100 were included in this paper. Systemic pharmacokinetics are available for most antiparasitic drugs but in many cases, not for all the relevant patient populations and only for single- or multiple-dose administration. Systemic pharmacokinetic data in patients with organ impairment and target-site pharmacokinetic data for relevant tissues and body fluids are mostly lacking. To improve the treatment of patients with parasitic diseases, research in these areas is urgently needed.
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Affiliation(s)
- Valentin Al Jalali
- Department of Clinical Pharmacology, Vienna University Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Vienna University Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Lombardo FC, Perissutti B, Keiser J. Activity and pharmacokinetics of a praziquantel crystalline polymorph in the Schistosoma mansoni mouse model. Eur J Pharm Biopharm 2019; 142:240-246. [PMID: 31265895 DOI: 10.1016/j.ejpb.2019.06.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/03/2019] [Accepted: 06/28/2019] [Indexed: 01/10/2023]
Abstract
Schistosomiasis is a global disease of significant public health relevance. Only one racemic drug, praziquantel, characterized by low bioavailability, low water solubility and extensive first pass metabolism, is currently available. We studied a new praziquantel formulation (polymorph B), which is based on a racemic praziquantel crystalline polymorph (TELCEU01). Its in vitro activity was tested on newly transformed schistosomula (NTS) and adult Schistosoma mansoni. In vivo studies were conducted in mice harboring chronic S. mansoni infections. Pharmacokinetic (PK) profiles of R- and S-praziquantel and R- and S- polymorph B following oral administration with both formulations were generated by sampling mice at 30, 60, 240 min and 24 h post-treatment, followed by LC-MS/MS analysis. PK parameters were calculated using a non-compartmental analysis with a linear trapezoidal model. In vitro, commercial praziquantel and the polymorph B performed similarly on both NTS (IC50 = 2.58 and 2.40 µg/mL at 72 h) and adults (IC50 = 0.05 and 0.07 µg/mL at 72 h). Praziquantel showed higher in vivo efficacy with an ED50 of 58.75 mg/kg compared to an ED50 of 122.61 mg/kg for the polymorph B. The PK profiles of the two drugs exhibited differences: R-praziquantel showed an overall 40% higher area under the plasma drug concentration-time curve (AUC0→24) (R-praziquantel = 3.42; R-polymorph B = 2.05 h*µg/mL) and an overall 30% lower apparent clearance (Cl/F) (R-praziquantel = 70.68 and R-polymorph B = 97.63 (mg)/(µg/mL)/h). Despite the lack of improved activity and PK properties of polymorph B against S. mansoni, here presented; research on pharmaceutical polymorphism remains a valid and cost-effective option for the development of new praziquantel formulations with enhanced properties such as increased solubility and/or dissolution.
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Affiliation(s)
- Flavio C Lombardo
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002 Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4001 Basel, Switzerland
| | - Beatrice Perissutti
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, p.le Europa 1, 34127 Trieste, Italy
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4002 Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
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11
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Radwan A, El-Lakkany NM, William S, El-Feky GS, Al-Shorbagy MY, Saleh S, Botros S. A novel praziquantel solid lipid nanoparticle formulation shows enhanced bioavailability and antischistosomal efficacy against murine S. mansoni infection. Parasit Vectors 2019; 12:304. [PMID: 31208446 PMCID: PMC6580642 DOI: 10.1186/s13071-019-3563-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Schistosomiasis is responsible for a considerable global disease burden. This work aimed to improve the therapeutic outcome of the only available antischistosomal drug worldwide, praziquantel (PZQ), by incorporating it into a novel carrier, “solid lipid nanoparticles (SLNs)”, to enhance its solubility, bioavailability and efficacy. A simple, cost-effective method was used to prepare SLN-PZQ. Results Compared to market PZQ (M-PZQ), SLN-PZQ was more bioavailable, as denoted by higher serum concentrations in both normal and infected mice where elevated Ka, AUC0–24, Cmax, and t1/2e with a decrease in kel were demonstrated. The AUC0–24 for SLN-PZQ in normal and Schistosoma mansoni-infected groups was almost nine- and eight-fold higher, respectively, than that for M-PZQ in corresponding groups. In normal and S. mansoni-infected mice, SLN-PZQ was detectable in serum at 24 h, while M-PZQ completely vanished 8 h post-treatment. Additionally, enhanced absorption with extended residence time was recorded for SLN-PZQ. Compared to M-PZQ, SLN-PZQ revealed superior antischistosomal activity coupled with enhanced bioavailability in all treated groups where higher percentages of worm reduction were recorded with all dosages tested. This effect was especially evident at the lower dose levels. The ED95 of SLN-PZQ was 5.29-fold lower than that of M-PZQ, with a significantly higher reduction in both the hepatic and intestinal tissue egg loads of all treated groups and almost complete disappearance of immature deposited eggs (clearly evident at the low dose levels). Conclusions SLN-PZQ demonstrated enhanced PZQ bioavailability and antischistosomal efficacy with a safe profile despite the prolonged residence in the systemic circulation.
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Affiliation(s)
- Amr Radwan
- Research Department, Academy of Scientific Research and Technology, Cairo, Egypt.
| | - Naglaa M El-Lakkany
- Pharmacology Department, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt
| | - Samia William
- Parasitology Department, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt
| | - Gina S El-Feky
- Pharmaceutical Technology Department, National Research Center, Giza, Egypt
| | - Muhammad Y Al-Shorbagy
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Cairo University, Giza, Egypt.,School of Pharmacy, Newgiza University, Giza, Egypt
| | - Samira Saleh
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Sanaa Botros
- Pharmacology Department, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt
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12
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Kim AV, Shelepova EA, Selyutina OY, Meteleva ES, Dushkin AV, Medvedev NN, Polyakov NE, Lyakhov NZ. Glycyrrhizin-Assisted Transport of Praziquantel Anthelmintic Drug through the Lipid Membrane: An Experiment and MD Simulation. Mol Pharm 2019; 16:3188-3198. [PMID: 31198045 DOI: 10.1021/acs.molpharmaceut.9b00390] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Praziquantel (PZQ) is one of the most widespread anthelmintic drugs. However, the frequent insufficient application of PZQ after oral administration is associated with its low solubility, penetration rate, and bioavailability. In the present study, the permeation of PZQ through a 1,2-dioleoyl- sn-glycero-3-phosphocholine (DOPC) membrane was investigated to probe glycyrrhizin-assisted transport. Glycyrrhizin (or glycyrrhizic acid, GA), a natural saponin, shows the ability to enhance the therapeutic activity of various drugs when it is used as a drug delivery system. However, the molecular mechanism of this effect is still under debate. In the present study, the transport rate was measured experimentally by a parallel artificial membrane permeation assay (PAMPA) and molecular dynamics (MD) simulation with DOPC lipid bilayers. The formation of the noncovalent supramolecular complex of PZQ with disodium salt of GA (Na2GA) in an aqueous solution was proved by the NMR relaxation technique. PAMPA experiments show a strong increase in the amount of the penetrating praziquantel molecules in comparison with a saturated aqueous solution of pure drug used as a control. MD simulation of PZQ penetration through the bilayer demonstrates an increase in permeability into the membrane in the presence of a glycyrrhizin molecule. A decrease in the free energy barrier in the middle of the lipid bilayer was obtained, associated with the hydrogen bond between PZQ and GA. Also, GA reduces the local bilayer surface resistance to penetration of PZQ by rearranging the surface lipid headgroups. This study clarifies the mechanism of increasing the drug's bioavailability in the presence of glycyrrhizin.
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Affiliation(s)
- Alexandra V Kim
- Institute of Chemical Kinetics and Combustion , Institutskaya Street, 3 , 630090 , Novosibirsk , Russia.,Novosibirsk State University , 630090 Novosibirsk , Russia
| | - Ekaterina A Shelepova
- Institute of Chemical Kinetics and Combustion , Institutskaya Street, 3 , 630090 , Novosibirsk , Russia.,Novosibirsk State University , 630090 Novosibirsk , Russia
| | - Olga Yu Selyutina
- Institute of Chemical Kinetics and Combustion , Institutskaya Street, 3 , 630090 , Novosibirsk , Russia
| | - Elizaveta S Meteleva
- Institute of Solid State Chemistry and Mechanochemistry , 630128 Novosibirsk , Russia
| | - Alexander V Dushkin
- Institute of Solid State Chemistry and Mechanochemistry , 630128 Novosibirsk , Russia
| | - Nikolai N Medvedev
- Institute of Chemical Kinetics and Combustion , Institutskaya Street, 3 , 630090 , Novosibirsk , Russia.,Novosibirsk State University , 630090 Novosibirsk , Russia
| | - Nikolay E Polyakov
- Institute of Chemical Kinetics and Combustion , Institutskaya Street, 3 , 630090 , Novosibirsk , Russia.,Institute of Solid State Chemistry and Mechanochemistry , 630128 Novosibirsk , Russia
| | - Nikolay Z Lyakhov
- Institute of Solid State Chemistry and Mechanochemistry , 630128 Novosibirsk , Russia
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13
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Ozdemir Z, Faki HE, Uney K, Tras B. Investigation of pharmacokinetic interaction between ivermectin and praziquantel after oral administration in healthy dogs. J Vet Pharmacol Ther 2019; 42:497-504. [PMID: 31183888 DOI: 10.1111/jvp.12769] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to determine the pharmacokinetic interaction between ivermectin (0.4 mg/kg) and praziquantel (10 mg/kg) administered either alone or co-administered to dogs after oral treatment. Twelve healthy cross-bred dogs (weighing 18-21 kg, aged 1-3 years) were allocated randomly into two groups of six dogs (four females, two males) each. In first group, the tablet forms of praziquantel and ivermectin were administered using a crossover design with a 15-day washout period, respectively. Second group received tablet form of ivermectin plus praziquantel. The plasma concentrations of ivermectin and praziquantel were determined by high-performance liquid chromatography using a fluorescence and ultraviolet detector, respectively. The pharmacokinetic parameters of ivermectin following oral alone-administration were as follows: elimination half-life (t1/2λz ) 110 ± 11.06 hr, area under the plasma concentration-time curve (AUC0-∞ ) 7,805 ± 1,768 hr. ng/ml, maximum concentration (Cmax ) 137 ± 48.09 ng/ml, and time to reach Cmax (Tmax ) 14.0 ± 4.90 hr. The pharmacokinetic parameters of praziquantel following oral alone-administration were as follows: t1/2λz 7.39 ± 3.86 hr, AUC0-∞ 4,301 ± 1,253 hr. ng/ml, Cmax 897 ± 245 ng/ml, and Tmax 5.33 ± 0.82 hr. The pharmacokinetics of ivermectin and praziquantel were not changed, except Tmax of praziquantel in the combined group. In conclusion, the combined formulation of ivermectin and praziquantel can be preferred in the treatment and prevention of diseases caused by susceptible parasites in dogs because no pharmacokinetic interaction was determined between them.
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Affiliation(s)
- Zeynep Ozdemir
- Anatolia Medicine & Chemical Industry Corporation, Konya, Turkey
| | - Hatice Eser Faki
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Selcuk, Konya, Turkey
| | - Kamil Uney
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Selcuk, Konya, Turkey
| | - Bunyamin Tras
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Selcuk, Konya, Turkey
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14
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The effect of ketoconazole on praziquantel pharmacokinetics and the role of CYP3A4 in the formation of X-OH-praziquantel and not 4-OH-praziquantel. Eur J Clin Pharmacol 2019; 75:1077-1087. [DOI: 10.1007/s00228-019-02663-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
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15
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Meteleva ES, Chistyachenko YS, Suntsova LP, Khvostov MV, Polyakov NE, Selyutina OY, Tolstikova TG, Frolova TS, Mordvinov VA, Dushkin AV, Lyakhov NZ. Disodium salt of glycyrrhizic acid – A novel supramolecular delivery system for anthelmintic drug praziquantel. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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16
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Eyoh E, McCallum P, Killick J, Amanfo S, Mutapi F, Astier AL. The anthelmintic drug praziquantel promotes human Tr1 differentiation. Immunol Cell Biol 2019; 97:512-518. [PMID: 30623486 DOI: 10.1111/imcb.12229] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/28/2018] [Accepted: 01/07/2019] [Indexed: 12/20/2022]
Abstract
Praziquantel (PZQ) is an anthelminthic human and veterinary drug used to treat trematode and cestode worms. Changes in immune responses have been demonstrated in humans following curative PZQ treatment of schistosome infections. These changes have been attributed to the removal of immunosupressive worms and immune responses to parasite antigens exposed from dying worms. To date, there has been no study investigating the potential direct effect of PZQ on the host immune cells. Herein, we analyzed the effect of PZQ on human CD4+ T cells classically costimulated by CD3/CD28 or costimulated by the complement regulator CD46 to induce Type 1 regulatory T cells (Tr1). Our results show that PZQ enhanced T-cell proliferation, increased secretion of IL-17 and IL-10 but had no effect on secretion of GM-CSF or IFNγ. Moreover, PZQ increased the coexpression of CD49b and LAG-3, a hallmark of Tr1 cells, suggesting increased Tr1 differentiation. Indeed, supernatants from PZQ-treated cells were able to decrease bystander T-cell activation, and this was partly reduced when blocking IL-10. Hence, our study demonstrates that PZQ directly modulates human T-cell activation and promotes Tr1 differentiation, suggesting that PZQ may have immunomodulatory functions in parasite-unrelated human inflammatory diseases.
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Affiliation(s)
- Enwono Eyoh
- Institute of Immunology & Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - Patrick McCallum
- Institute of Immunology & Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - Justin Killick
- The MRC Centre for Inflammation Research, Edinburgh Centre for MS research, University of Edinburgh, Edinburgh, UK
| | - Seth Amanfo
- Institute of Immunology & Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - Francisca Mutapi
- Institute of Immunology & Infection Research and Centre for Immunity, Infection and Evolution, School of Biological Sciences, Ashworth Laboratories, University of Edinburgh, King's Buildings, Edinburgh, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), Ashworth Laboratories, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - Anne L Astier
- The MRC Centre for Inflammation Research, Edinburgh Centre for MS research, University of Edinburgh, Edinburgh, UK.,Centre de Physiopathologie Toulouse-Purpan (CPTP) INSERM U1043, CNRS U5282, Université de Toulouse, Toulouse, France
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17
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Bonate PL, Wang T, Passier P, Bagchus W, Burt H, Lüpfert C, Abla N, Kovac J, Keiser J. Extrapolation of praziquantel pharmacokinetics to a pediatric population: a cautionary tale. J Pharmacokinet Pharmacodyn 2018; 45:747-762. [PMID: 30218416 PMCID: PMC6182730 DOI: 10.1007/s10928-018-9601-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Abstract
L-praziquantel (PZQ) pharmacokinetic data were analyzed from two relative bioavailability Phase 1 studies in adult, healthy subjects with two new oral dispersion tablet (ODT) formulations of L-PZQ administered under various combinations of co-administration with food, water, and/or crushing. Linear mixed effects models adequately characterized the noncompartmental estimates of the pharmacokinetic profiles in both studies. Dose, food, and formulation were found to significantly affect L-PZQ exposure in both studies. The model for AUC was then extrapolated to children 2–5 years old accounting for enzyme maturation and weight. The predicted exposures were compared to an external Phase 1 study conducted by the Swiss Tropical and Public Health Institute using a currently marketed formulation (Cesol 600 mg immediate-release tablets) and found to be substantially lower than observed. A root cause analysis was completed to identify the reason for failure of the models. Various scenarios were proposed and tested. Two possible reasons for the failure were identified. One reason was that the model did not account for the reduced hepatic clearance seen in patients compared to the healthy volunteer population used to build the model. The second possible reason was that PZQ absorption appears sensitive to meal composition and the model did not account for differences in meals between a standardized Phase 1 unit and clinical sites in Africa. Further studies are needed to confirm our hypotheses.
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Affiliation(s)
| | - Tianli Wang
- Astellas, 1 Astellas Way, Northbrook, IL, 60062, USA.,Alkermes, Waltham, MA, 02451, USA
| | - Paul Passier
- Astellas, 1 Astellas Way, Northbrook, IL, 60062, USA.,Galapagos BV, Zernikedreef 16, Leiden, The Netherlands
| | - Wilhelmina Bagchus
- Merck Serono SA, Merck Institute for Pharmacometrics (A Subsidiary of Merck KGaA, Darmstadt, Germany), Lausanne, Switzerland
| | - Howard Burt
- Simcyp (a Certara company), Blades Enterprise Centre, John Street, Sheffield, S2 4SU, UK
| | - Christian Lüpfert
- Merck KGaA, Translational Quantitative Pharmacology, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Nada Abla
- Merck Global Health Institute, Ares Trading S.A. (A Subsidiary of Merck KGaA, Darmstadt, Germany), 1262, Eysins, Switzerland
| | - Jana Kovac
- Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Socinstr. 57, CH-4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
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18
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Lack of Clinical Pharmacokinetic Studies to Optimize the Treatment of Neglected Tropical Diseases: A Systematic Review. Clin Pharmacokinet 2018; 56:583-606. [PMID: 27744580 PMCID: PMC5425494 DOI: 10.1007/s40262-016-0467-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) affect more than one billion people, mainly living in developing countries. For most of these NTDs, treatment is suboptimal. To optimize treatment regimens, clinical pharmacokinetic studies are required where they have not been previously conducted to enable the use of pharmacometric modeling and simulation techniques in their application, which can provide substantial advantages. OBJECTIVES Our aim was to provide a systematic overview and summary of all clinical pharmacokinetic studies in NTDs and to assess the use of pharmacometrics in these studies, as well as to identify which of the NTDs or which treatments have not been sufficiently studied. METHODS PubMed was systematically searched for all clinical trials and case reports until the end of 2015 that described the pharmacokinetics of a drug in the context of treating any of the NTDs in patients or healthy volunteers. RESULTS Eighty-two pharmacokinetic studies were identified. Most studies included small patient numbers (only five studies included >50 subjects) and only nine (11 %) studies included pediatric patients. A large part of the studies was not very recent; 56 % of studies were published before 2000. Most studies applied non-compartmental analysis methods for pharmacokinetic analysis (62 %). Twelve studies used population-based compartmental analysis (15 %) and eight (10 %) additionally performed simulations or extrapolation. For ten out of the 17 NTDs, none or only very few pharmacokinetic studies could be identified. CONCLUSIONS For most NTDs, adequate pharmacokinetic studies are lacking and population-based modeling and simulation techniques have not generally been applied. Pharmacokinetic clinical trials that enable population pharmacokinetic modeling are needed to make better use of the available data. Simulation-based studies should be employed to enable the design of improved dosing regimens and more optimally use the limited resources to effectively provide therapy in this neglected area.
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Abstract
Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.
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Affiliation(s)
- Derick N. M. Osakunor
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Mark E. J. Woolhouse
- Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Francisca Mutapi
- Centre for Immunity, Infection and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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20
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Visser M, Zaya MJ, Locuson CW, Boothe DM, Merritt DA. Comparison of predicted intrinsic hepatic clearance of 30 pharmaceuticals in canine and feline liver microsomes. Xenobiotica 2018; 49:177-186. [PMID: 29405805 DOI: 10.1080/00498254.2018.1437933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. Known cytochrome P450 (CYP) substrates in humans are used in veterinary medicine, with limited knowledge of the similarity or variation in CYP metabolism. Comparison of canine and feline CYP metabolism via liver microsomes report that human CYP probes and inhibitors demonstrate differing rates of intrinsic clearance (CLint). 2. The purpose of this study was to utilize a high-throughput liver microsome substrate depletion assay, combined with microsomal and plasma protein binding to compare the predicted hepatic clearance (CLhep) of thirty therapeutic agents used off-label in canines and felines, using both the well-stirred and parallel tube models. 3. In canine liver microsomes, 3/30 substrates did not have quantifiable CLint, while midazolam and amitriptyline CLint was too rapid for accurate determination. A CLhep was calculated for 29/30 substrates in feline microsomes. Overall, canine CLhep was faster compared to the feline, with fold differences ranging from 2-20-fold. 4. A comparison between the well-stirred and parallel tube model indicates that the parallel tube model reports a slighter higher CLhep in both species. 5. The differences in CYP metabolism between canine and feline highlight the need for additional research into CYP expression and specificity.
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Affiliation(s)
- Marike Visser
- a VMRD Global Therapeutics, Zoetis , Kalamazoo , MI , USA
| | | | | | - Dawn M Boothe
- d College of Veterinary Medicine, Auburn University , Auburn , AL , USA
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21
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da Silva VBR, Campos BRKL, de Oliveira JF, Decout JL, do Carmo Alves de Lima M. Medicinal chemistry of antischistosomal drugs: Praziquantel and oxamniquine. Bioorg Med Chem 2017; 25:3259-3277. [DOI: 10.1016/j.bmc.2017.04.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/21/2017] [Accepted: 04/26/2017] [Indexed: 12/20/2022]
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22
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Praziquantel for Schistosomiasis: Single-Drug Metabolism Revisited, Mode of Action, and Resistance. Antimicrob Agents Chemother 2017; 61:AAC.02582-16. [PMID: 28264841 DOI: 10.1128/aac.02582-16] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Schistosomiasis, a major neglected tropical disease, affects more than 250 million people worldwide. Treatment of schistosomiasis has relied on the anthelmintic drug praziquantel (PZQ) for more than a generation. PZQ is the drug of choice for the treatment of schistosomiasis; it is effective against all major forms of schistosomiasis, although it is less active against juvenile than mature parasites. A pyrazino-isoquinoline derivative, PZQ is not considered to be toxic and generally causes few or transient, mild side effects. Increasingly, mass drug administration targeting populations in sub-Saharan Africa where schistosomiasis is endemic has led to the appearance of reduced efficacy of PZQ, which portends the selection of drug-resistant forms of these pathogens. The synthesis of improved derivatives of PZQ is attracting attention, e.g., in the (i) synthesis of drug analogues, (ii) rational design of pharmacophores, and (iii) discovery of new compounds from large-scale screening programs. This article reviews reports from the 1970s to the present on the metabolism and mechanism of action of PZQ and its derivatives against schistosomes.
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23
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Population Pharmacokinetics and Pharmacodynamics of Praziquantel in Ugandan Children with Intestinal Schistosomiasis: Higher Dosages Are Required for Maximal Efficacy. mBio 2016; 7:mBio.00227-16. [PMID: 27507822 PMCID: PMC4992966 DOI: 10.1128/mbio.00227-16] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Each year, millions of African children receive praziquantel (PZQ) by mass drug administration (MDA) to treat schistosomiasis at a standard single dose of 40 mg/kg of body weight, a direct extrapolation from studies of adults. A higher dose of 60 mg/kg is also acceptable for refractory cases. We conducted the first PZQ pharmacokinetic (PK) and pharmacodynamic (PD) study in young children comparing dosing. Sixty Ugandan children aged 3 to 8 years old with egg patent Schistosoma mansoni received PZQ at either 40 mg/kg or 60 mg/kg. PK parameters of PZQ racemate and enantiomers (R and S) were quantified. PD outcomes were assessed by standard fecal egg counts and novel schistosome-specific serum (circulating anodic antigen [CAA]) and urine (circulating cathodic antigen [CCA]) antigen assays. Population PK and PD analyses were performed to estimate drug exposure in individual children, and the relationship between drug exposure and parasitological cure was estimated using logistic regression. Monte Carlo simulations were performed to identify better, future dosing regimens. There was marked PK variability between children, but the area under the concentration-time curve (AUC) of PZQ was strongly predictive of the parasitological cure rate (CR). Although no child achieved antigenic cure, which is suggestive of an important residual adult worm burden, higher AUC was associated with greater CAA antigenic decline at 24 days. To optimize the performance of PZQ, analysis of our simulations suggest that higher doses (>60 mg/kg) are needed, particularly in smaller children. Schistosomiasis is a neglected tropical disease, typically associated with chronic morbidity, and its control is a global health priority. Praziquantel (PZQ) is the only available antiparasitic drug and is often given out, as a single oral dose (40 mg/kg), to school-aged children by mass drug administration (MDA) schemes operating within preventive chemotherapy campaigns as endorsed by the World Health Organization (WHO). This current strategy has several limitations. (i) It excludes preschool children who can be patently infected. (ii) It delivers PZQ at a dose directly extrapolated from adult pharmacological studies. To address these problems, we conducted the first pharmacokinetic and pharmacodynamic study of young children within an area of Uganda where Schistosoma mansoni is hyperendemic. Our results demonstrate that a higher dose (>60 mg/kg) is required, especially in smaller children, and draw attention to the need for further optimization of PZQ treatment based on schistosome antigenic assays, which are more sensitive to pharmacodynamic markers.
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Abstract
Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajnish Pathania
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Babu Ram Thakur
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajesh Chopra
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Praziquantel coverage in schools and communities targeted for the elimination of urogenital schistosomiasis in Zanzibar: a cross-sectional survey. Parasit Vectors 2016; 9:5. [PMID: 26727915 PMCID: PMC4700672 DOI: 10.1186/s13071-015-1244-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/03/2015] [Indexed: 12/26/2022] Open
Abstract
Background Biannual mass drug administration (MDA) with praziquantel and additional interventions to eliminate urogenital schistosomiasis has been implemented on the Zanzibar islands, United Republic of Tanzania, since 2012. We aimed to assess the coverage of school-based treatment (SBT) and community-wide treatment (CWT), to validate the coverage reported by the Zanzibar Ministry of Health (MoH) and to identify reasons for non-compliance. Methods We conducted a post-MDA cross-sectional survey in 93 schools and 92 communities on Pemba and Unguja islands in early 2014, 3–5 months after the last MDA round. Pupils and adults were asked whether they had received and taken the praziquantel treatment provided in the last SBT or CWT, respectively, and the observed and reported coverage were compared. Reasons for non-compliance were recorded in a pretested questionnaire and assessed in qualitative interviews. Urine samples of participants were examined for Schistosoma haematobium eggs with a single urine filtration. Results Around 8000 pupils and 4000 adults were included in the analysis. Our survey revealed a SBT coverage of 85.2 % in Pemba and of 86.9 % in Unguja, which was in line with MoH reports from Pemba (84.3 %) and higher than reports from Unguja (63.9 %). However, 15 among the 48 schools surveyed in Unguja had not received SBT. Among the interviewed adults, 53.6 % in Pemba and 64.9 % in Unguja had received praziquantel during CWT, which was less than the 59.0 % and 67.7 %, respectively, indicated by MoH reports. Moreover, only 43.8 % and 54.0 % of adults in Pemba and Unguja, respectively, had taken all the tablets as recommended. The main reasons for not receiving or taking praziquantel were absence during CWT, no drug distributor coming, being busy, fear of adverse events, pregnancy, breastfeeding or feeling healthy. Conclusion To increase coverage and compliance in Zanzibar, SBT should target all schools and mobilization, sensitization and implementation of the CWT need to be improved. To reach elimination of urogenital schistosomiasis transmission in Zanzibar and elsewhere, a very high treatment coverage and compliance at national and local level is key and additional control measures such as snail control and behaviour change interventions will need to be implemented area wide. Trial Registration ISRCTN48837681.
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Muhumuza S, Olsen A, Katahoire A, Nuwaha F. Reduced uptake of mass treatment for schistosomiasis control in absence of food: beyond a randomized trial. BMC Infect Dis 2015; 15:423. [PMID: 26466681 PMCID: PMC4606967 DOI: 10.1186/s12879-015-1158-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/30/2015] [Indexed: 11/11/2022] Open
Abstract
Background Sustaining high uptake of praziquantel is key for long-term control of schistosomiasis. During mass treatment in 2013, we randomized 12 primary schools into two groups; one group received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. The uptake of praziquantel in the snack schools was 94 % compared to 79 % in the non-snack schools. During mass treatment in 2014, no snack was provided. We compared the uptake of praziquantel in 2014 to that in 2013 and attempt to explain the reasons for the observed differences. Methods Serial cross sectional surveys were conducted among a random sample of children from the 12 primary schools, 1 month after mass treatment in 2013 and 2014 to measure uptake of praziquantel, reported side effects attributable to praziquantel and prevalence and intensity of schistosomiasis infection. Differences in the demographic and descriptive variables between the 2013 and 2014 samples were compared using chi squared tests for categorical variables and student’s t-test for geometric mean intensity of S. mansoni infection. Results Uptake of praziquantel reduced from 93.9 to 78.0 % (p = 0.002) in the snack schools but was unchanged in the non-schools 78.7 and 70.4 % (p = 0.176). The occurence of side-effects attributable to praziquantel increased from 34.4 to 61.2 % (p = 0.001) in the snack schools but was unchanged in the non-snack schools; 46.9 and 53.2 % (p = 0.443). Although the prevalence of S. mansoni infection increased in both the snack and non-snack schools, the differences did not reach statistical significance;1.3 and 7.5 % (p = 0.051) and 14.1 and 22.0 % (p = 0.141), respectively. Similarly, the difference in the geometric mean intensity of S. mansoni infection in both the snack and non-snack schools was not statistically significant; 38.3 eggs per gram of stool (epg) and 145.7 epg (p = 0.197) and 78.4 epg and 322.5 epg (p = 0.120), respectively. Conclusion Our results show that in absence of food, uptake of praziquantel reduced and the side-effects of the drug increased. However, the reduced uptake did not affect the prevalence and intensity of schistosomiasis among school children. Rescinding of the provision of the snack is what probably caused the reduction in uptake of treatment in the subsequent mass treatment cycle.
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Affiliation(s)
- Simon Muhumuza
- School of Medicine, Child Health and Development Center, Makerere University, Kampala, Uganda.
| | - Annette Olsen
- Faculty of Health and Medical Sciences, Section for Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Katahoire
- School of Medicine, Child Health and Development Center, Makerere University, Kampala, Uganda.
| | - Fred Nuwaha
- School of Public Health, Makerere University, Kampala, Uganda.
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Effectiveness of a pre-treatment snack on the uptake of mass treatment for schistosomiasis in Uganda: a cluster randomized trial. PLoS Med 2014; 11:e1001640. [PMID: 24824051 PMCID: PMC4019501 DOI: 10.1371/journal.pmed.1001640] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/24/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment. METHODS AND FINDINGS In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively. CONCLUSIONS Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection. TRIAL REGISTRATION www.ClinicalTrials.gov NCT01869465
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Schistosomiasis, a common parasitic disease, can change the pharmacokinetics of certain drugs, thereby affecting clinical outcomes. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Schistosomiasis is a common parasitic disease, with over 230 million people requiring treatment annually. The worldwide increase in medication access poses risks for patients living in regions endemic for schistosomiasis because of the potential impact of pharmacokinetic changes on clinical outcomes. Thus, the objective of this review is to summarize and evaluate the published literature reporting pharmacokinetic parameters of medications in patients with schistosomiasis and to assess associated clinical implications. Thirteen articles that described the pharmacokinetics of a total of 9 different medications (cefoperazone, propranolol, praziquantel, theophylline, metronidazole, acetaminophen/paracetamol, antipyrine, oxamniquine, and oral contraceptives) in patients with schistosomiasis were included in the review. The major finding is that pharmacokinetic changes occur in patients infected with schistosomiasis but to varying degrees depending on the extent of disease (e.g., varying stages of fibrosis, with or without signs and/or symptoms of liver disease) and medication being administered. Affected patients may consequently be at risk of adverse clinical outcomes. In general, drugs with high extraction ratios demonstrate increased bioavailability in patients with schistosomiasis compared to controls. For example, propranolol and praziquantel, respectively, show an association with increased clinical and toxic effects in patients with schistosomiasis. Conversely, the pharmacokinetics of low hepatic clearance drugs (such as metronidazole and oxamniquine) are largely unchanged unless patients present with liver disease (as in the case of antipyrine, the prototypical low clearance drug). Limitations of studies included the very small numbers of patients, being primarily single-dose studies, and the high inter-individual variability. Future clinical studies should include pharmacokinetic outcomes to further clarify dosing and administration strategies for target medications, especially those that primarily undergo metabolism and are associated with significant adverse effects. Until the results of these future studies are available, clinicians should be acutely aware of complications from schistosomiasis and carefully screen patients for signs and symptoms of liver disease prior to prescribing, dispensing, or administering potentially harmful medications.
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Olliaro P, Delgado-Romero P, Keiser J. The little we know about the pharmacokinetics and pharmacodynamics of praziquantel (racemate and R-enantiomer). J Antimicrob Chemother 2014; 69:863-70. [PMID: 24390933 DOI: 10.1093/jac/dkt491] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Praziquantel has been the mainstay of schistosomiasis control since 1984 and widely distributed since 2006 through 'preventive chemotherapy' programmes to school-aged children or at-risk populations. In addition, preschool-aged children are now recognized as a vulnerable population and a group for targeted treatment, but they may be difficult to dose correctly with the available product--a racemate, based on the biologically active enantiomer (R-praziquantel) and the inactive distomer (S-praziquantel), which contributes the bitter taste and doubles the size of the tablets. Hence, a paediatric formulation is required, possibly enantiomerically pure. Developing such a product and extending its use to younger children should be pharmacologically guided, but limited data exist on pharmacokinetics and pharmacokinetic/pharmacodynamic correlations for praziquantel. This article presents available data on the chemistry, pharmacokinetics and pharmacodynamics of praziquantel, as well as R-praziquantel, and points to gaps in our knowledge.
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Affiliation(s)
- Piero Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme on Research & Training in Tropical Diseases (TDR), World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland
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Muhumuza S, Katahoire A, Nuwaha F, Olsen A. Increasing teacher motivation and supervision is an important but not sufficient strategy for improving praziquantel uptake in Schistosoma mansoni control programs: serial cross sectional surveys in Uganda. BMC Infect Dis 2013; 13:590. [PMID: 24330594 PMCID: PMC3866576 DOI: 10.1186/1471-2334-13-590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Realization of the public health benefits of mass drug administration (MDA) for the control of schistosomiasis depends on achieving and maintaining high annual treatment coverage. In Uganda, the uptake of preventive treatment for schistosomiasis among school-age children in 2011 was only 28%. Strategies are needed to increase uptake. METHODS Serial cross-sectional surveys were conducted at baseline (after MDA in 2011) and at follow-up MDA in 2012 where teacher motivation was provided and supervision strengthened in Jinja district of Uganda. Uptake of praziquantel was assessed in 1,010 randomly selected children from 12 primary schools during the baseline survey and in another set of 1,020 randomly selected children from the same primary schools during the follow-up survey. RESULTS Self-reported uptake of praziquantel increased from 28.2% (95% CI 25.4%-30.9%) at baseline to 48.9% (95% CI 45.8%-52.0%) (p < 0.001) at follow-up. Prevalence and intensity of Schistosoma mansoni infection were unchanged and moderate on both occasions; 35.0% (95% CI: 25.4%-37.9%) and 32.6% (95% CI: 29.6%-35.5%) (p = 0.25) and 156.7 eggs per gram of stool (epg) (95% CI: 116.9-196.5) and 133.1 epg (95% CI: 99.0-167.2) (p = 0.38), respectively. There was no change in the proportion of children reporting side effects attributable to praziquantel at baseline (49.8%, 95% CI 43.8%-55.8%) and at follow-up (46.6%, 95% CI 42%.1-51.2%) (p = 0.50) as well as in the proportion of children with correct knowledge of schistosomiasis transmission and control between the baseline (45.9%, 95% CI 42.7%-73.7%) and follow-up (44.1%, 95% CI 41.0%- 47.2%) (p = 0.42). CONCLUSION Although teacher motivation and supervision to distribute treatment increased the uptake of praziquantel among school-age children, the realized uptake is still lower than is recommended by the World Health Organization (WHO) and apparently too low to affect the prevalence and intensity of schistosomiasis among the children. Additional measures are needed to increase uptake of praziquantel if school-based MDA is to achieve the objective of preventive chemotherapy.
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Affiliation(s)
- Simon Muhumuza
- School of Medicine, Child Health and Development Center, Makerere University, Kampala, Uganda.
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Pengsaa K, Na-Bangchang K, Limkittikul K, Kabkaew K, Lapphra K, Sirivichayakul C, Wisetsing P, Pojjaroen-Anant C, Chanthavanich P, Subchareon A. Pharmacokinetic investigation of albendazole and praziquantel in Thai children infected withGiardia intestinalis. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:349-57. [PMID: 15228716 DOI: 10.1179/000349804225003398] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The pharmacokinetics of albendazole/albendazole sulphoxide and praziquantel were investigated in Thai children with Giardia infection. Twenty school-age children were randomly allocated to receive either a single oral dose of albendazole (400 mg/child) or the same dose of albendazole given concurrently with a single oral dose of praziquantel (20 mg/kg). The concentrations of albendazole/albendazole sulphoxide and praziquantel in plasma samples, collected at intervals in the first 24 h post-treatment, were then quantified using HPLC with ultra-violet detection. No significant pharmacokinetic interaction between the albendazole and praziquantel was demonstrated. For albendazole sulphoxide, the active metabolite of albendazole, there was marked inter-individual variation in the maximum plasma concentration and the 'area under the curve'. The pharmacokinetics of albendazole sulphoxide were similar whether albendazole was given alone or in combination with praziquantel.
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Affiliation(s)
- K Pengsaa
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratthewee, Bangkok 10400, Thailand.
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Kumar V, Gryseels B. Use of praziquantel against schistosomiasis: a review of current status. Int J Antimicrob Agents 2012; 4:313-20. [PMID: 18611623 DOI: 10.1016/0924-8579(94)90032-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/1994] [Indexed: 10/27/2022]
Abstract
Praziquantel therapy has become an important component of any programme directed towards schistosomiasis control. This disease being prevalent in many disadvantaged countries, where the means and resources are limited, the strategies for its control on a large scale are also beset with various other constraints. In this review, the potentials of praziquantel therapy in containing the intensities, prevalences and schistosomiasis-associated morbidities in endemic areas of different geographical and epidemiological settings are examined. By and large, regular community-based treatment produces a longer term favourable impact on infection levels and morbidity, but the impact on the disease transmission appears limited. Children constitute a high risk group in schistosomiasis. They are usually subjected to more rapid and intense reinfection, but they also appear more responsive to praziquantel therapy in preventing or reversing the effects of the disease. Modern techniques used in the assessment of impact of praziquantel treatment in schistosomiasis control are outlined.
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Affiliation(s)
- V Kumar
- Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerp 1, Belgium
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El-Lakkany N, Seif el-Din SH, Heikal L. Bioavailability and in vivo efficacy of a praziquantel–polyvinylpyrrolidone solid dispersion in Schistosoma mansoni-infected mice. Eur J Drug Metab Pharmacokinet 2012; 37:289-99. [DOI: 10.1007/s13318-012-0089-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/06/2012] [Indexed: 11/27/2022]
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Olliaro PL, Vaillant MT, Belizario VJ, Lwambo NJS, Ouldabdallahi M, Pieri OS, Amarillo ML, Kaatano GM, Diaw M, Domingues AC, Favre TC, Lapujade O, Alves F, Chitsulo L. A multicentre randomized controlled trial of the efficacy and safety of single-dose praziquantel at 40 mg/kg vs. 60 mg/kg for treating intestinal schistosomiasis in the Philippines, Mauritania, Tanzania and Brazil. PLoS Negl Trop Dis 2011; 5:e1165. [PMID: 21695161 PMCID: PMC3114749 DOI: 10.1371/journal.pntd.0001165] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 04/12/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Praziquantel at 40 mg/kg in a single dose is the WHO recommended treatment for all forms of schistosomiasis, but 60 mg/kg is also deployed nationally. METHODOLOGY/PRINCIPAL FINDINGS Four trial sites in the Philippines, Mauritania, Tanzania and Brazil enrolled 856 patients using a common protocol, who were randomised to receive praziquantel 40 mg/kg (n = 428) or 60 mg/kg (n = 428). While the sites differed for transmission and infection intensities (highest in Tanzania and lowest in Mauritania), no bias or heterogeneity across sites was detected for the main efficacy outcomes. The primary efficacy analysis was the comparison of cure rates on Day 21 in the intent-to-treat population for the pooled data using a logistic model to calculate Odd Ratios allowing for baseline characteristics and study site. Both doses were highly effective: the Day 21 cure rates were 91.7% (86.6%-98% at individual sites) with 40 mg/kg and 92.8% (88%-97%) with 60 mg/kg. Secondary parameters were eggs reduction rates (ERR), change in intensity of infection and reinfection rates at 6 and 12 months. On Day 21 the pooled estimate of the ERR was 91% in both arms. The Hazard Ratio for reinfections was only significant in Brazil, and in favour of 60 mg/kg on the pooled estimate (40 mg/kg: 34.3%, 60 mg/kg: 23.9%, HR = 0.78, 95% CI = [0.63;0.96]). Analysis of safety could not distinguish between disease- and drug-related events. 666 patients (78%) reported 1327 adverse events (AE) 4 h post-dosing. The risk of having at least one AE was higher in the 60 than in the 40 mg/kg group (83% vs. 73%, p<0.001). At 24 h post-dosing, 456 patients (54%) had 918 AEs with no difference between arms. The most frequent AE was abdominal pain at both 4 h and 24 h (40% and 24%). CONCLUSION A higher dose of 60 mg/kg of praziquantel offers no significant efficacy advantage over standard 40 mg/kg for treating intestinal schistosomiasis caused by either S. mansoni or S. japonicum. The results of this study support WHO recommendation and should be used to inform policy decisions in the countries.
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Affiliation(s)
- Piero L. Olliaro
- UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Michel T. Vaillant
- Methodology and Statistical Unit, Center for Health Studies, Centre de Recherche – Santé, Strassen, Luxembourg
| | - Vincente J. Belizario
- National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Nicholas J. S. Lwambo
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Mohamed Ouldabdallahi
- Nutrition et Actes Médicaux, Institut National de Recherches en Santé Publique (INRSP), Nouakchott, Mauritania
| | - Otavio S. Pieri
- Laboratorio de Eco-Epidemiologia e Controle da Esquistossomose e Geohelmintoses, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria L. Amarillo
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Godfrey M. Kaatano
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Mamadou Diaw
- Ministère de la Santé/P.E.V., Nouakchott, Mauritania
| | - AnaLucia C. Domingues
- Departamento de Medicina Clinica, Centro de Ciencias da Saude, UFPE, Hospital das Clinicas, Recife, Brazil
| | - Tereza C. Favre
- Laboratorio de Eco-Epidemiologia e Controle da Esquistossomose e Geohelmintoses, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Olivier Lapujade
- UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Fabiana Alves
- Latin America Regional Office, Drugs for Neglected Diseases Initiative, Rio de Janeiro, Brazil
| | - Lester Chitsulo
- Preventive Chemotherapy and Transmission Control Unit, Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Ahmed Ali S. Natural Products as Therapeutic Agents for Schistosomiasis. RESEARCH JOURNAL OF MEDICINAL PLANT 2011. [DOI: 10.3923/rjmp.2011.1.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bygott JM, Chiodini PL. Praziquantel: neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease? Acta Trop 2009; 111:95-101. [PMID: 19375409 DOI: 10.1016/j.actatropica.2009.04.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 04/08/2009] [Accepted: 04/08/2009] [Indexed: 12/28/2022]
Abstract
The role of praziquantel in hydatid disease has not been well defined. This review evaluates the evidence on the use of praziquantel in treatment of cystic hydatid disease from in vitro and in vivo animal studies, human clinical studies and case reports. Praziquantel may prevent the vesicular evolution of protoscoleces and inhibit the formation of secondary cysts. It may also contribute to the loss of viability of small cysts before cyst differentiation and development of the fibrous adventitial layer. There is some evidence to support a role for the use of praziquantel in combination with albendazole in pre- and post-intervention chemotherapy for hydatid disease. Combined therapy may reduce the risk of disease recurrence and intraperitoneal seeding of infection that develops via cyst rupture and spillage occurring spontaneously or during surgery or percutaneous procedures. At present, there is insufficient published evidence to support a clear recommendation for the use of praziquantel in prolonged chemotherapy for established hydatid disease for which surgery is not indicated or in severe disseminated disease and further work is necessary. Randomised controlled studies to determine the efficacy and optimum duration of praziquantel treatment in combination with albendazole are required so that treatment recommendations for its use can finally be clarified.
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Affiliation(s)
- J M Bygott
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London WC1E 6JB, UK.
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Treatment of urinary schistosomiasis: methodological issues and research needs identified through a Cochrane systematic review. Parasitology 2009; 136:1837-49. [PMID: 19493363 DOI: 10.1017/s0031182009005939] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Guidelines recommend praziquantel (PZQ) for the treatment and control of schistosomiasis, with no real alternative. Metrifonate was still widely used against Schistosoma haematobium in the 1990s, and then withdrawn. Experimental studies and clinical trials suggest that artemisinin compounds are active against S. haematobium. In a Cochrane systematic review assessing the efficacy and safety of drugs for treating urinary schistosomiasis, 24 randomized controlled trials (n=6315 individuals) met our inclusion criteria. These trials compared a variety of single agent and combination regimens with PZQ, metrifonate or artemisinin derivatives. The review confirmed that both the standard recommended doses of PZQ (single 40 mg/kg oral dose) and metrifonate (3x7.5-10 mg/kg oral doses administered fortnightly) are efficacious and safe in treating urinary schistosomiasis, but there is no study comparing these two regimens head-to-head. There is currently not enough evidence to evaluate artemisinin compounds. Most of the studies included in the Cochrane systematic review were insufficiently powered, lacked standardization in assessing and reporting outcomes, and had a number of methodological limitations. In this paper we discuss the implications of these findings with respect to public health and research methodology and propose priority research needs.
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Ridtitid W, Ratsamemonthon K, Mahatthanatrakul W, Wongnawa M. Pharmacokinetic interaction between ketoconazole and praziquantel in healthy volunteers. J Clin Pharm Ther 2007; 32:585-93. [DOI: 10.1111/j.1365-2710.2007.00862.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Botros SS, El-Din SHS, El-Lakkany NM, Sabra ANA, Ebeid FA. DRUG-METABOLIZING ENZYMES AND PRAZIQUANTEL BIOAVAILABILITY IN MICE HARBORING SCHISTOSOMA MANSONI ISOLATES OF DIFFERENT DRUG SUSCEPTIBILITIES. J Parasitol 2006; 92:1344-9. [PMID: 17304818 DOI: 10.1645/ge-865r.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The level of drug-metabolizing enzymes (cytochrome P450 [CYP450] and cytochrome b5 [cyt b5]) and the bioavailability of praziquantel (PZQ) were investigated in batches of mice infected with Schistosoma mansoni displaying either a decreased susceptibility to PZQ ("EE2" and "BANL"-isolates), or a normal susceptibility to the drug ("CD" isolate). Each batch was divided into 2 groups. The first group was further subdivided into 5 subgroups. Subgroups 1 to 4 were treated 7 wk postinfection (PI) with oral PZQ at 25, 50, 100, and 200 mg/kg for 5 consecutive days, whereas the fifth subgroup was administered the vehicle only as control. Animals were perfused 9 wk PI, and worms were counted to estimate PZQ ED50. CYP450 and cyt b5 were examined in hepatic microsomes of infected untreated mice and of infected mice treated with 25 and 200 mg/ kg PZQ. The second group was given PZQ 7 wk PI and was further subdivided into 11 subgroups, killed at 2, 5, 15, 30, 60, 90, 120, 150, 180, 240, and 360 min postdosing to study pharmacokinetic parameters of PZQ. Mice harboring S. mansoni isolates having higher PZQ ED50 (170.3 mg/kg for EE2 and 249.9 mg/kg for BANL vs. 82.96 mg/kg for CD) had higher levels of CYP450 and cyt b5, a PZQ Cmax decreased by 19-30% and area under the serum concentration-time curve0-6 hr decreased by 57-74%. Data suggest that S. mansoni isolates that are less sensitive to PZQ induce a lower inhibition of hepatic drug-metabolizing enzymes, with a consequently higher metabolic transformation of PZQ.
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Affiliation(s)
- Sanaa S Botros
- Department of Pharmacology, Theodor Bilharz Research Institute, Warrak El-Hadar, Imbaba, P.O. Box 30, Giza 12411, Egypt.
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Doenhoff MJ, Pica-Mattoccia L. Praziquantel for the treatment of schistosomiasis: its use for control in areas with endemic disease and prospects for drug resistance. Expert Rev Anti Infect Ther 2006; 4:199-210. [PMID: 16597202 DOI: 10.1586/14787210.4.2.199] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Praziquantel became available for the treatment of schistosomiasis and other trematode-inflicted diseases in the 1970s. It was revolutionary because it could be administered orally and had very few unwanted side effects. As a result of marked reductions in the price of praziquantel, the rate at which it is used has accelerated greatly in recent years. For the foreseeable future it will be the mainstay of programs designed to control schistosome-induced morbidity, particularly in sub-Saharan Africa where schistosomiasis is heavily endemic. There is currently no evidence to suggest that any schistosomes have developed resistance to praziquantel as a result of its widespread use. Nevertheless, while resistance may not pose an obvious or immediate threat to the usefulness of praziquantel, complacency and a failure to monitor developments may have serious consequences in the longer term since it will be the only drug that is readily available for large-scale treatment of schistosomiasis.
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Affiliation(s)
- Michael J Doenhoff
- University of Wales Bangor, School of Biological Sciences, Bangor, Gwynedd LL576 2UW, UK.
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Na-Bangchang K, Kietinun S, Pawa KK, Hanpitakpong W, Na-Bangchang C, Lazdins J. Assessments of pharmacokinetic drug interactions and tolerability of albendazole, praziquantel and ivermectin combinations. Trans R Soc Trop Med Hyg 2006; 100:335-45. [PMID: 16271272 DOI: 10.1016/j.trstmh.2005.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 05/11/2005] [Accepted: 05/11/2005] [Indexed: 11/28/2022] Open
Abstract
The pharmacokinetic interactions and tolerability of albendazole, praziquantel and ivermectin combinations were assessed in 23 healthy Thai volunteers (12 males and 11 females). The study was an open, randomised, three-way crossover design in which each subject attended the study on three separate occasions (Phases I, II and III), of 4 d or 8 d each, with at least 1 or 2 weeks (but not longer than 2 months) between each phase. All subjects received the three study drug regimens as follows: regimen I, oral praziquantel (40 mg/kg body weight); regimen II, oral ivermectin (200 microg/kg body weight) given concurrently with an oral dose of albendazole (400 mg); and regimen III, oral ivermectin given concurrently with albendazole and praziquantel. All treatment regimens showed acceptable tolerability profiles. The incidence of overall drug-related adverse events was significantly higher following regimens I (12/23) and III (7/23) compared with that following regimen II (0/23). Six statistically significant changes in the pharmacokinetic parameters of albendazole sulphoxide (Cmax, AUC0-infinity, Vz/F, CL/F), praziquantel (Vz/F) and ivermectin (AUC0-infinity) were observed when the three drugs were given concurrently. However, based on US Food and Drug Administration criteria, these changes were not considered of clinical relevance.
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Affiliation(s)
- K Na-Bangchang
- Pharmacology and Toxicology Unit, Faculty of Allied Health Sciences, 99 Mu 18 Thammasat University (Rangsit Campus), Klong Loung, Pathumthani 12121, Thailand.
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Melo AJ, Iamamoto Y, Maestrin APJ, Smith JRL, Santos MD, Lopes NP, Bonato PS. Biomimetic oxidation of praziquantel catalysed by metalloporphyrins. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.molcata.2004.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hanpitakpong W, Banmairuroi V, Kamanikom B, Choemung A, Na-Bangchang K. A high-performance liquid chromatographic method for determination of praziquantel in plasma. J Pharm Biomed Anal 2004; 36:871-6. [PMID: 15533682 DOI: 10.1016/j.jpba.2004.07.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2004] [Revised: 07/26/2004] [Accepted: 07/31/2004] [Indexed: 10/26/2022]
Abstract
A simple, sensitive, selective and reproducible method based on a reversed-phase chromatography was developed for the determination of praziquantel in human plasma. Praziquantel was separated from the internal standard (diazepam) on a Luna C18 column (250 mm x 4.6mm, 5 microm particle size), with retention times of 4.8 and 6.2 min, respectively. Ultraviolet detection was set at 21 7 nm. The mobile phase consisted of acetonitrile and distilled water (70:30, v/v), running through the column at a flow rate of 1.0 ml/min. The chromatographic analysis was operated at 25 degrees C. Sample preparation (1 ml plasma) was done by a single step liquid-liquid extraction with the mixture of methyl-tert-butylether and dichloromethane at the ratio of 2:1 (v/v). Calibration curves in plasma at the concentrations 0, 50, 100, 200, 400, 800 and 1600 ng/ml were all linear with correlation coefficients better than 0.999. The precision of the method based on within-day repeatability and reproducibility (day-to-day variation) was below 15% (relative standard deviation: R.S.D.). Good accuracy was observed for both the intra-day or inter-day assays, as indicated by the minimal deviation of mean values found with measured samples from that of the theoretical values (below +/-15%). Limit of quantification (LOQ) was accepted as 5 ng using 1 ml samples. The mean recovery for praziquantel and the internal standard were greater than 90% for both praziquantel and internal standard. The method was free from interference from the commonly used antibiotic and antiparasitic drugs. The method appears to be robust and has been applied to a pharmacokinetic study of praziquantel in three healthy Thai volunteers following a single oral dose of 40 mg/kg body weight praziquantel.
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Affiliation(s)
- Warunee Hanpitakpong
- Faculty of Allied Health Sciences, Pharmacology and Toxicology Unit, Thammasat University (Rangsit Campus), Paholyothin Road, Pathumthani 12121, Thailand
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Utzinger J, Keiser J. Schistosomiasis and soil-transmitted helminthiasis: common drugs for treatment and control. Expert Opin Pharmacother 2004; 5:263-85. [PMID: 14996624 DOI: 10.1517/14656566.5.2.263] [Citation(s) in RCA: 243] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Schistosomiasis is a disease caused by parasitic trematode worms (schistosomes) that currently affects 200 million people living in tropical and subtropical environments. It is a chronic disease and the latest estimates for sub-Saharan Africa are that it kills > 200000 people every year. Soil-transmitted helminthiasis (STH) is caused by intestinal nematodes. More than 2 billion people are infected worldwide and the disease burden might approach that of malaria. Recognising the enormous public health significance of schistosomiasis and STH, particularly among the poor, and in view of readily available drugs that are safe, efficacious and inexpensive, the World Health Assembly recently set forth a resolution for a combined approach for morbidity control of both diseases. This review briefly summarises the geographical distribution, life cycle and global burden of schistosomiasis and STH. The current arsenal of drugs available for morbidity control, including discovery, chemistry, pharmacological properties and aspects of therapeutic efficacy and adverse events in clinical human use is then discussed. The emphasis is on praziquantel, oxamniquine and artemisinin derivatives (against schistosomes) and albendazole, mebendazole, levamisole, pyrantel pamoate and other compounds (against intestinal nematodes). The experience gained with combination chemotherapy in schistosomiasis and STH is briefly discussed. Finally, current research needs and the critical importance for development of novel anthelmintic drugs, so that chemotherapy can continue to serve as the backbone of integrated and sustainable control of schistosomiasis and STH, is highlighted.
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Affiliation(s)
- Jürg Utzinger
- Office of Population Research, Princeton University, Princeton University, NJ 08544, USA.
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Utzinger J, Keiser J, Shuhua X, Tanner M, Singer BH. Combination chemotherapy of schistosomiasis in laboratory studies and clinical trials. Antimicrob Agents Chemother 2003; 47:1487-95. [PMID: 12709312 PMCID: PMC153321 DOI: 10.1128/aac.47.5.1487-1495.2003] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jürg Utzinger
- Office of Population Research, Princeton University, Princeton, New Jersey 08544, USA.
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Abstract
The pharmacokinetics and toxicity of albendazole, mebendazole and praziquantel are extensively reviewed, drawing on original published work and reviews in the open scientific literature and on assessments by international agencies and official regulatory bodies in Europe and the USA. Information about human and veterinary medical uses and adverse reactions is evaluated. The totality of the non-clinical information available about these long-established drugs may not comply with current official guidelines for new medicines but reasons are given why the "deficiencies" are only apparent and the data gaps can be replaced by other results, largely obtained from the target species and the many years of clinical experience of safe use of these drugs in humans and animals.
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Affiliation(s)
- A D Dayan
- Parasitic Diseases and Vector Control (PVC), Communicable Diseases Control, Prevention and Eradication (CPE), World Health Organization, CH-1211 Geneva 27, Switzerland.
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Ridtitid W, Wongnawa M, Mahatthanatrakul W, Punyo J, Sunbhanich M. LC determination of praziquantel in human plasma. J Pharm Biomed Anal 2002; 28:181-6. [PMID: 11861122 DOI: 10.1016/s0731-7085(01)00605-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A simple high-performance liquid chromatographic (HPLC) method for the determination of praziquantel in human plasma was developed and validated. The present method was described by adding drop-wise 0.2 M Zinc sulfate and acetonitrile to plasma sample for deproteinization. This method used a reversed-phase Spherisorb ODS 2 column (5 microm), 250 x 4.6 mm i.d. as a stationary phase with a mobile phase consisting of acetonitrile- methanol-water (36:10:54, v/v/v), a flow rate of 1.5 ml/min and UV detection wavelength of 217 nm. Diazepam was used as internal standard. The standard calibration curve was linear over the concentration range of 100-2000 ng/ml (r=0.999). The equation of a linear regression line was y=8.05E-04+7.25E-04x with slope and intercept values of 0.0007 and 0.0008, respectively. The limit of detection was 12.25 ng/ml and the limit of quantification was set at 100 ng/ml. The intra- and inter-day assay coefficients of variation (CV) were 3.0+/-1.7 and 6.3+/-1.9%, respectively. The percentage of recovery was 102.1+/-5.6. Therefore, the HPLC method described here was simple, rapid and reproducible since it did not require extraction and evaporation processes in sample preparation, which will reduce time-consuming or expensive sample preparation.
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Affiliation(s)
- Wibool Ridtitid
- Department of Pharmacology, Faculty of Science, Prince of Songkla University, Hat Yai, Songkla, Thailand.
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Utzinger J, Chollet J, You J, Mei J, Tanner M, Xiao S. Effect of combined treatment with praziquantel and artemether on Schistosoma japonicum and Schistosoma mansoni in experimentally infected animals. Acta Trop 2001; 80:9-18. [PMID: 11495639 DOI: 10.1016/s0001-706x(01)00138-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Praziquantel and artemether are safe and efficacious antischistosomal drugs that act against different developmental stages of the parasite: praziquantel against adult worms and artemether against schistosomula. A combined treatment has been suggested as a strategy for transmission control. Recent laboratory experiments with rabbits with a mixed infection of Schistosoma japonicum parasites of different ages confirmed the effectiveness of a combination therapy. In the present work, we assessed the effect of a combined treatment on adult worms of S. japonicum and found significantly higher worm reduction rates than with a single dose of praziquantel. In a next step, we extended the study of the combined treatment to Schistosoma mansoni. A combined treatment with 75 mg/kg praziquantel and 150 mg/kg artemether was administered to hamsters infected with juvenile and adult S. mansoni. The two drugs, administered simultaneously or spaced by 6 h, 1, 3 or 7 days, resulted in significantly higher worm reduction rates than a single treatment with praziquantel. A combination therapy with increased doses of 100 mg/kg praziquantel and 300 mg/kg artemether showed very high worm reduction rates of 90% and above, however, some hamsters died in five different combined treatment experiments, suggesting that these drug concentrations were too high. We conclude that a combined treatment with praziquantel and artemether at the lower doses is safe and more effective than praziquantel alone, which forms a foundation for designing respective clinical trials in humans.
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Affiliation(s)
- J Utzinger
- Swiss Tropical Institute, P.O. Box, CH-4002, Basel, Switzerland
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